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6.2 Viral infections

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6.2.A Chickenpox Clinical presentation Management Prevention 6.2.B Dengue Diagnosis Pathogenesis of severe dengue or dengue haemorrhagic fever (DHF) Dengue or dengue fever (non-severe dengue) has only phases 1 and 3. Management of dengue and severe dengue (dengue haemorrhagic fever, DHF) Management of severe dengue with shock and respiratory distress Initial management of shock 2 Give a bolus of Ringer-lactate or Hartmann’s or 0.9% Haematocrit of normal child is usually 35–36%, so if a child has haematocrit > 42% this means that it has risen to 20% or more above normal level. Intractable shock with respiratory distress Fluid management Crystalloids Inotropic drugs Severe dengue with organ involvement Prevention and control 6.2.C Acute hepatitis Management of acute hepatitis Hepatitis A Hepatitis B Hepatitis C Hepatitis E Epstein–Barr virus (EBV) Cytomegalovirus (CMV) Parvovirus B19 6.2.D Human Immunodeficiency Virus (HIV) infection Introduction Epidemiology Natural history data Diagnostic issues Clinical diagnosis Counselling and testing Laboratory diagnosis *If the child is breastfeeding, a negative diagnostic test, either serological or virological, would have to be repeated 6 weeks after cessation of all breastfeeding. HIV antibody test (ELISA or rapid tests) Virological testing Other laboratory tests Assessment of HIV-infected and HIV- exposed children Perinatally acquired HIV infection Prevention of mother-to-child transmission (PMTCT) of HIV and infant feeding in the context of HIV Breastfeeding Management of the child with a suspected or proven HIV infection Clinical staging of HIV infection Antiretroviral drugs Triple therapy is the standard of care. Formulations First-line ART for children under 3 years of age First-line ART for children aged 3 years or older (including adolescents) When to start ART Infants and children with specific conditions Side effects of antiretroviral therapy and monitoring Monitoring the response after ARV initiation Long-term follow-up Monitoring the response (see Appendix 1) When to change treatment First-line regimen treatment failure; when to switch regimens Principles Immune reconstitution inflammatory syndrome (IRIS) What is IRIS? Who is at risk of developing IRIS? When does IRIS develop? What are the common manifestations of IRIS? How should IRIS be managed? Second-line treatment regimens in the event of treatment failure Third-line ART Nutritional care and failure to thrive (see Appendix 3) Clinical management Respiratory disorders in children with HIV infection Specific HIV-related causes of infection and illness Pneumocystis jiroveci (formerly carinii) pneumonia (PCP) Co-trimoxazole prophylaxis Who should be given co-trimoxazole? For how long should co-trimoxazole be given? Under what circumstances should co-trimoxazole be discontinued? What doses of co-trimoxazole should be used? What follow-up is required? Lymphocytic interstitial pneumonitis (LIP) Treatment of LIP Isoniazid preventive therapy (IPT) Investigations Treatment of infants and children diagnosed with TB and HIV Recommended ART regimens for children who need TB treatment Recommended regimens for children and adolescents initiating ART while on TB treatment Recommended regimens for children and infants initiating TB treatment while receiving ART Bronchiectasis Cytomegalovirus (CMV) Other lung infections Treatment for oral candida Oesophageal candidiasis Treatment for oesophageal candidiasis Viral oesophagitis Herpes simplex virus (HSV) Severe periodontal and gingival disease (cancrum oris) Persistent diarrhoea (see Section 5.12.B) Chronic or recurrent diarrhoea Investigations Abdominal pain Malabsorption Central nervous system disorders Specific neurological problems Encephalitis JC virus (papovavirus) Fungal lesion Diffuse CMV encephalitis Meningitis Bacterial meningitis Cryptococcosis and other fungi Syphilis Tuberculosis Cerebral abscess Skin disorders Seroconversion rash Viral infections Varicella HSV 1 and 2 Molluscum contagiosum Measles Viral warts Bacterial infections Fungal infection Seborrhoeic dermatitis and pityriasis versicolor Non-specific pruritic papular rash Treatment Drug side effects Infestations Malignancy Fever of unknown origin Immunisation Terminal care of children dying from HIV infection Pain control for children with HIV Need for referral Summary Appendix 1 * If signs of clinical progression of disease are seen, the CD4 count should be done earlier. Appendix 3 Summary of nutritional recommendations and support for HIV-infected children Appendix 4 a This dose of Ddl is only approximate for children aged 3 months or older and weighing between 6 kg and 6.9 kg. a EFV is not recommended for children under 3 years and weighing less than 10 kg. 6.2.E Measles Epidemiology Clinical features Diagnosis Laboratory findings Complications Tracheobronchitis Otitis media Stomatitis Xerophthalmia Malnutrition Tuberculosis Encephalitis Differential diagnosis Case assessment and classification Danger signs Management Severe measles Prevention and follow-up 6.2.F Mumps Clinical presentation Complications Management Prevention 6.2.G Poliomyelitis Introduction Severity Minor illness Major illness Paralytic poliomyelitis Prognosis Management Acute phase Convalescent phase Prevention 6.2.H Rabies management and prevention after animal bites Management Rabies prophylaxis Estimating the risk of exposure to rabies Post-exposure treatment Rabies vaccine Other vaccines Three post-exposure regimens (see Table 6.2.H.2) Standard five-dose intramuscular (IM) ‘Essen’ regimen Economical four-site intradermal (ID) regimen Economical two-site ID regimen Rabies immunoglobulin (RIG) Section 5.1.B) Post-exposure treatment for previously vaccinated adults Two post-exposure booster regimens (see Table 6.2.H.2) Standard two-dose IM regimen Economical single-day four-site ID regimen Pre-exposure treatment Indications for pre-exposure rabies prophylaxis Pre-exposure three-dose regimen (see Table 6.2.H.2) Summary For all cases: IM, intramuscular; ID, intradermal. 6.2.I Viral hemorrhagic fevers Lassa fever Prevalence Clinical features Diagnosis of Lassa fever Supportive indirect laboratory tests Confirmation of diagnosis Management Ebola Prevalence Clinical disease (data for adults) Diagnosis of Ebola Indirect laboratory tests supportive of diagnosis Confirmation of diagnosis Infection control Notification Management Infection control of VHFs Barrier nursing — Only essential samples should be taken. Which patients should be isolated? Isolation of suspected and probable cases on presentation to hospital Differential diagnosis of VHFs Further reading 6.2.J Yellow fever Introduction Epidemiology Pathophysiology Clinical features Laboratory diagnosis Management Prevention